Antibacterial Test between Aloe vera and Chlorhexidine ...pustaka.unpad.ac.id/.../uploads/2016/01/...aloe-vera-and-chlorhexidine.pdf · interactions can affect bacterial cell membranes,

International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064

Index Copernicus Value (2013): 6.14 | Impact Factor (2014): 5.611

Volume 5 Issue 1 January 2016

www.ijsr.net Licensed Under Creative Commons Attribution CC BY

Antibacterial Test between Aloe vera and

Chlorhexidine Based on the Number of Colony of

Streptococcus mutans Atcc 25 175 In Vitro

Yetty Herdiyati Nonong1, Mieke Hemiawati Satari

2, Ratna Indriyanti

3, Selly Patawulandari

4

1,2,3,4Universitas Padjadjaran, Faculty of Dentistry, Sekeloa Selatan I St, Bandung, West Java, Indonesia 40132

Abstract: Streptococcus mutans is a bacterium which has an important role in the process of dental caries. This bacterium is able to

ferment sucrose to glucans that serves as a medium for the initial adhesion of bacteria on the teeth and produces acid that plays a role in

the occurrence of dental caries. Aloe vera is an herb that has many health benefits, one of which is an antibacterial effect. Antibacterial

Effects of Aloe vera works by inhibiting bacterial metabolism and cause the disruption of the cell membrane permeability so that the

growth of Streptococcus mutans can be inhibited. Chlorhexidine is a broad spectrum anti-microbial material with the ability to prevent

caries that are widely used in dentistry. The research objective was to analyze the difference in the decrease of number of colonies of

Streptococcus mutans between Aloe vera and Chlorhexidine in vitro. The study was conducted using pure experimental research on

media containing artificial saliva, cultured Streptococcus mutans ATCC 25 175, 20% sucrose, then Aloe vera and Chlorhexidine were

applied. Paired t-test is used for statistical analysis to analyze the decrease in the number of colonies of Streptococcus mutans in the

treatment group and Chlorhexidine Aloe vera. Results of t-test showed that there is a difference in decreasing the number of colonies of

Streptococcus mutans significantly between Aloe vera and Chlorhexidine with p-value of 0.0399 (α <0.05). The research concludes that

there is a significant difference in the decrease of the number of colonies of Streptococcus mutans in Aloe vera and Chlorhexidine

treatment group in vitro.

Keywords: caries, Streptococcus mutans, Aloe vera, chlorhexidine.

1. Introduction

Dental caries is the dental hard tissue damage caused by acid

products of fermentation of carbohydrate by bacteria.

Sucrose fermenting bacteria produce acid. The main

bacterium responsible for producing acid and caries is

Streptococcus mutans. These bacteria are considered as the

most important bacteria in the process of caries. [1], [2]

Streptococcus mutans is a bacterium that causes the onset of

caries because of the virulence factors that are characteristic

of the bacteria. Streptococcus mutans is an anaerobic

bacterium that produces lactic acid as part of metabolites and

able to adhere to the tooth surface in the presence of sucrose

as the substrate. Streptococcus mutans produces lactic acid

which can cause salivary pH decreases to below 5.5 (the

critical pH). A decrease in the pH of saliva which repeatedly

and continuously can cause demineralization of the tooth

surface and eventually dental caries. Demineralization is a

state of loss of ions of calcium, phosphate, hydroxyl of the

hydroxy apatite crystals, and the solubility of hydroxy apatite

that can occur at a pH below 5.5 (the critical pH).[1],[2],[3]

High caries prevalence increases the number of colonies of

Streptococcus mutans, so caries prevention with anti-

bacterial ingredients to eliminate the growth of

Streptococcus mutans is needed.[4]

Caries prevention has been studied in various ways one of

which uses a chemical that has been done by Miller in 1890

which estimates that an antiseptic to kill bacteria and limit

the amount or activity of bacteria. Antibacterial drugs have

become part of preventive dentistry since many years ago.

Antibacterial agents with broad spectrum can be used to

reduce the accumulation of plaque - biofilm or damage the

microbial cell.[5]

Chlorhexidine is a chemical with broad-spectrum

antibacterial activity, which is effective against gram positive

and gram negative. Chlorhexidine mouthwash is the gold

standard as an antibacterial. Chlorhexidine is highly effective

in reducing gingivitis and plaque accumulation.

Chlorhexidine is an anti-bacterial agent; the agent is working

on the cytoplasmic membrane. Chlorhexidine has a molecule

that can bind to the cation anion molecules in bacteria. These

interactions can affect bacterial cell membranes, which leads

to increased permeability of the bacterial cell wall.

Furthermore disrupted cell osmotic balance and lead to

leakage component intracellular. [5],[ 6],[ 7]

The clinical use of chlorhexidine is widely known, but

chlorhexidine have side effects if used in the long term. Side

effects that occur are brown discoloration on the teeth,

tongue, and denture restorative materials, desquamation and

pain in the oral mucosa, oral mucosal irritation and dry

mouth. Besides, disorders of taste and bitter taste may occur,

so poorly received by children anak.[5],[8]

Regarding the side

effects of chlorhexidine above, herbal alternative materials

which do not have these side effect is now being developed.

Aloe vera has become the alternative herbal plants. This herb

can be used as an antibacterial agent that replace chemicals

because it is safe, no side effects and less expensive.[9]

Aloe vera contains active substances such as anthraquinone,

saponins, acemannan, polysaccharides, salicylic acid, a

hormone, tannins, aloin, aloe-emodin, aloetic acids,

flavonoids, saponins, sterols, amino acids, enzymes,

minerals, and vitamins. Of the active ingredients, there are

some that have anti-bacterial effect such as anthraquinone,

phenols, acemannan, saponin.[10]

Anthraquinone is composed of aloe emodin, aloetic acid,

anthranol, chrysophanic acid, cinnamic acid. This

Paper ID: NOV153049 1379





antibacterial effect works by blocking the action of an

enzyme in the biosynthetic process peptidoglycan and

lipopolysaccharide/lipotekhoat,damaging the plasma

membrane and causes disruption of membrane permeability

so that the growth of bacteria can be inhibited.[11],[12]

Besides,

anthraquinone also have similar properties as soap, which

can reduce the surface tension of cytoplasmic membrane of

the bacterial cell so that the cell membrane permeability

decreases. Saponin contained glycosides have astringent

properties of soap as a cleanser and antiseptic. Saponins can

dissolve lipids in the cell membrane of bacteria

(lipoproteins), thereby decreasing surface tension lipids, and

cause bacterial cell function becomes abnormal, lysis and

mati.[11],[12]

The existence of Aloe vera components such as

anthraquinone and saponin can kill bacteria directly, while

other components such as acemannan can work as an

antibacterial indirectly by stimulating the phagocytosis

process leukosit.[13],[14]

Aloin, a yellow-colored compound, is

a C-glycoside derivative of anthraquinone. Aloin and aloe-

emodin has strong antibacterial. Aloin and aloe-emodin is

the main anthraquinone, which has the polyphenol structure

that is capable of inhibiting the protein synthesis of the

bacterial cell. Anti-bacterial ability of Aloe vera shows broad

spectrum against gram-positive bacteria and gram negatif.[11]

2. Research Method

The study was conducted at the Laboratory of Chemistry

Faculty of Mathematics and Natural Sciences (MIPA),

Padjadjaran University in media containing artificial saliva,

therein included cultured Streptococcus mutans ATCC 25

175 and 20% sucrose. Samples were given Chlorhexidine

and Aloe vera extracts to see a decrease in the number of

colonies of Streptococcus mutans ATCC 25 175.

The samples were divided into 6 groups, CHX-0

(Chlorhexidine day 0), CHX-1 (Chlorhexidine day 1), CHX-

2 (Chlorhexidine day 2), AV-1 (Aloe vera day 0), AV -2

(Aloe vera day-to-1), AV-3 (Aloe vera 2nd day).

Examination of the number of colonies of Streptococcus

mutans ATCC 25 175 done on days 0, 1st, and 2nd after the

samples were incubated and treated with antibacterial

ingredients. CHX 0 and AV 0 group were incubated after 1

hour ago then the number of colonies were examined. In the

group of CHX-1 and AV-1 examination is performed after 1

day of incubation, and after 2 days of incubation in CHX

group-2 and AV-2.

Prior to this research, determination of Minimum Inhibitory

Concentration on Aloe vera extract and Chlorhexidine has

been done. The goal is to determine the smallest

concentration of the extract of Aloe vera and Chlorhexidine

that still can inhibit the growth of Streptococcus mutans

ATCC 25175. Minimum Inhibitory Concentration Test

results on Aloe vera extract is 18.75% and the results of

Minimum Inhibitory Concentration on chlorhexidine is at

0.98 ppm.

3. Statistic Test

Results of the study would be tested using a paired t-test to

see equality between Aloe vera and Chlorhexidine based on a

decrease in the number of colonies of Streptococcus mutans.

4. Research Results

Table 4-1: S. mutans colony examination in chlorhexidine

(CFU/ml unit)

Table 4-1 shows the colony inspection CHX ke- day 0, day 1

CHX and CHX day 2 on the dilution concentration of 10-3

,

10-4

, 10-5

, and 10-6

on the first plate and the second plate,

each of which contained as many as 0 CFU / ml colony with

a mean concentration of each dilution of 0 CFU / ml. It

showed no growth of Streptococcus mutans in the

chlorhexidine from day 0 to day 2.

Figure 4.1: Clinical Appearance of Agar Plate of CHX day 0






Figure 4.2: Clinical Appearance of Agar Plate of CHX day 1

Figure 4.3:Clinical Appearance of Agar Plate of CHX day 2

Table 4-2: S. mutans colony examination in Aloe vera

(CFU/ml unit)

Table 4-2 shows the number of colonies Aloe vera

examination day 0, at a concentration of 10-3

dilution of the

colonies are counted 3 CFU / ml on the first plate and 7 CFU

/ ml in the second plate with the average of 5 CFU / ml. the

concentration of 10-4

dilution of the colonies contained as

much as 18 CFU / ml on the first plate and 5 CFU / ml in the

second plate with a mean of 11.5 CFU / ml. the

concentration of dilution 10-5

, colonies that grow as much as

1 CFU / ml on the first plate and the second plate shows the

colony as much as 0 CFU / ml with a mean of 0.5 CFU / ml.

the concentration dilution of 10-6

contained colony as much

as 0 CFU / ml on the first plate and the second plate with a

mean of 0 CFU / ml.

Aloe vera colony count examination day 1 at a dilution

concentration of 10-3 on the first agar plates shows the

number of colonies as much as 1 CFU / ml and in the second

plate of 0 CFU / ml with a mean of 0.5 CFU / ml. dilution

concentration of10-3

, 10-4

, 10-5

, and 10-6

in the first and

second plates both shows the number of colonies of 0 CFU /

ml with mean dilution concentrations of 0 CFU / ml. Aloe

vera colony count examination day 2 on the dilution

concentration of 10-3

, 10-4

, 10-5

, and 10-6

on the first and

second plate both shows the number of colonies of 0 CFU /

ml with mean dilution concentration of 0 CFU / ml.

Aloe vera extracts showed growth of Streptococcus mutans

colonies ranging from day 0 to day 1, while on day 2 showed

no colony growth of Streptococcus mutans.






Figure 4.4 Clinical Appearance of Agar Plate of Aloe vera

treatment day 0 (The arrows indicate the growth of

Streptococcus mutans colonies)

Figure 4.5 Clinical Appearance of Agar Plate of Aloe

vera treatment day 1

Figure 4.6 Clinical Appearance of Agar Plate of Aloe vera

treatment day 2

4.1 Statistic Test Results

T test is used for statistical testing to find equality of two

mean at the two populations to determine the difference in

decreasing of the number of Streptococcus mutans colonies

after Aloe vera and chlorhexidine treatment α < 0,05.






Table 4-3: T-Test Statistical Testing Analysis To Determine

The Differences Of The Decreased Of Streptococcus mutans

Total Colony After Aloe vera And Chlorhexidine Treatment

pvalue

Value

t count

Meaning

AV0 AV1 AV2

CHX0 0,399

1,89 Significant

CHX1

0,0352

1,96 Significant

CHX2 0,1671 1 Non Significant

Note: CHX0 : Chlorhexidine day 0, CHX 1 : Chlorhexidine

day 1, CHX 2 : Chlorhexidine day 2, AV0 : Aloe vera day 0,

AV1 : Aloe vera day 1, AV2 : Aloe vera day 2.

In the statistical testing by t-test, a significant difference is

seen between the Aloe vera day 0 group and Chlorhexidine

day 0 group with pvalue of 0.0399 and tcount of 1.89. In the

Aloe vera day 1 group and Chlorhexidine day 1 group, a

significant difference is seen with pvalue of 0.0352 and tcount

of1.96. In the Aloe vera day 2 group and chlorhexidine day

2, a significant difference is seen with pvalue of 0.1671 and

tcount of 1.

Conclusion: There is a significant difference at the reduction

of the number of Streptococcus mutans colonies on the Aloe

vera and Chlorhexidine application.

5. Discussion

Streptococcus mutans is a bacterium which has an important

role in the process of dental caries. This bacterium is able to

ferment sucrose to glucans that serves as a medium for the

initial adhesion of bacteria on the teeth and produces acid

that plays a role in the occurrence of dental caries. The acid

environment in the oral cavity is triggered by Streptococcus

mutans to metabolize sucrose. Streptococcus mutans

produces acids such as lactic acid as an end result the

metabolism of Streptococcus mutans with sucrose as the

substrate. Besides being able to produce acid, the bacteria are

also able to survive in acidic or low pH (asiduric)

environment. These bacteria are also more asidogenic than

other Streptococcus species. Therefore, Streptococcus

mutans is a key target in the efforts to prevent dental

caries.[15]

Streptococcus mutans forms extracellular polysaccharides

from sucrose, which is glucosyltransferase (GTF).

Glucosyltransferase (GTF) enzyme breaks down sucrose into

glucan. Glucan serves as a initial attachment medium of

bacteria to the tooth surface and facilitates the accumulation

of bacteria. Glucan adhesion on the surface of bacteria is

caused by the existence of another protein known as glucan

binding protein (GBP). This glucan attachment results in

properties of adhesive and cohesive of the plaque on the

tooth surface.[16]

This study was conducted to see a decrease in the number of

colonies of Streptococcus mutans between Aloe vera with

Chlorhexidine in vitro. The Media is conditioned in

anaerobic atmosphere at a temperature of 37oC, because the

temperature of 37oC is the optimum temperature for growth

of colonies of Streptococcus mutans. The research uses

sucrose at 20% both on the agar plates and the media, the

goal Streptococcus mutans could grow well and produce

more glucan so the colony size is big enough to facilitate the

colony counting process.

Chlorhexidine group showed no growth of colonies ranging

from days 0, 1, until day 2 (0 CFU / ml). This is caused by

chlorhexidine mechanism that can work progressively on the

cytoplasmic membrane. Chlorhexidine has a cationic

molecules that can bind groups of negatively charged

bacteria (containing sulfa and phosphate). This molecular

interactions causes chlorhexidine to be attracted to the

charged anion bacterial cell wall through a spesific and

strong adsorption (compound of phosphate). chlorhexidine

goes into the cytoplasm, cell membrane integrity

progressively destroyed, then the permeability of bacterial

cell wall is increased. Furthermore cell osmotic balance is

disrupted. chlorhexidine binds to phospholipids and causes

damage to the cell molecular weight (potassium ion).

Furthermore cytoplasm experiences coagulation and

precipitation in the cytoplasm of the phosphate groups (ATP

and nucleic acids), and finally there is leakage of

intracellular components, lysis and death. [5]

In addition,

chlorhexidine can inhibit glucosyltransferase enzymes that

are essential for microbial accumulation on tooth surfaces. [5].[17]

Chlorhexidine is a chemical with a broad spectrum of

antibacterial power, highly effective against gram-positive

bacteria. Chlorhexidine is used as the gold standard because

of its superiority compared to other mouthwash. Superior

effect is mainly ascribed to the chlorhexidine high

substantivity ability. chlorhexidine can penetrate the plaque

biofilm thus killing bacterial pathogens contained in

biofilms. Chlorhexidine can also bind tightly to the structure

of the teeth, dental plaque, and oral tissues. [5],[6]

research

conducted by Lakade et al showed a greater decrease in the

number of colonies of Streptococcus mutans in chlorhexidine

than the combined application of mouthwash containing

0.03% triclosan, 0.05% 5% sodium fluoride and xylitol.

chlorhexidine works by damaging the cell walls of

microorganisms that cause them to leak intracellular

component.4 previous study proved consistent with the

results of this study, colonies did not grow at all (0 CFU /

ml) on day 0 to day 2 either in the dilution of 10- 3

to 10-6

.

Statistically, no significant difference is in seen a decrease in

the number of colonies of Streptococcus mutans on

chlorhexidine ranging from day 0 to day 2. It is proved that

chlorhexidine has a superior antibacterial effect in reducing

the number of colonies of Streptococcus mutans.

Aloe vera showed relatively more colony growth in

comparison to chlorhexidine, but Aloe vera showed a good

decrease in the number of colonies starting from day 0 to day

2. colonies grew on day 0 at dilutions of 10-3

with a mean 5

CFU / ml, with a dilution concentration of 10-4

and mean of

11.5 CFU / ml, a dilution concentration of 10-5 and mean of

0.5 CFU / ml, and the dilution concentration 10-6

with a

mean of 0 CFU / ml. Colonies grew on day 1 only in dilution

10-3

with a mean of 0.5 CFU / ml, it is clear that the number

of bacterial colonies decreased considerably from day 0 to

day 1. Day 2 showed a quite effective decreased in the

absence of colonies that grow. Aloe vera extract is proven to

inhibit the number of colonies of Streptococcus mutans on

the concentration of 18.75% within 0 days, 1 and 2 days.






This proves that Aloe vera is able to decrease the number of

colonies of Streptococcus mutans, although in this study the

antibacterial effect Aloe vera is not as good as chlorhexidine.

Statistically, a significant decrease is shown in the group of

Aloe vera in reducing the number of colonies of

Streptococcus mutans. Aloe vera as an anti-bacterial cannot

be equal in reducing the number of colonies of Streptococcus

mutans.

Aloe vera is an herbal ingredient that has many benefits for

human health and readily available in the environment. Aloe

vera contains many active substance components comprising

anthraquinone, phenols, acemannan, and saponins are known

to have antibacterial properties. This antibacterial effect

works by blocking the action of an enzyme in the

biosynthetic process peptidoglycan and

lipopolysaccharide/lipotekhoat, damaging the plasma

membrane and disrupting membrane permeability so that

bacterial growth is inhibited. Anthraquinone and saponin has

an antibacterial effect which can kill bacteria directly,

whereas other components, acemannan, may work as an

antibacterial indirectly by stimulating phagocytosis of

leukocytes. Saponin as an antiseptic can dissolve lipids in the

cell membrane of bacteria (lipoprotein), interfere with the

function of bacterial cells and damage the cell membrane of

bacteria, lysis and die.[12], [18]

Mechanisms of phenolic compounds contained in Aloe vera

can cause inhibition of bacteria. Phenol compounds denature

the protein and increase the permeability of microorganisms.

The interaction between microorganisms produce changes in

the charge balance of protein molecules, resulting in changes

in the structure of the protein and causes coagulation.

Proteins that undergo denaturation and coagulation will lose

the physiological activity that it cannot function properly.

Changes in the structure of proteins in the cell wall of

bacteria will increase the permeability of the cell so that the

cell growth is inhibited, then the cells become damaged,

causing lysis of bacterial cells. Aloe vera in low

concentrations can damage the cytoplasmic membrane,

causing leakage of the cell wall, so that the growth of

bacteria will be inhibited.[11]

The mechanism of action of

Aloe vera works by damaging the cell membrane of bacteria

gradually, not as progressive as chlorhexidine.

Results of research on both the antimicrobial material

exhibited antibacterial effect which can reduce the number of

colonies of Streptococcus mutans. When compared

statistically, the ability of both anti-microbial materials is not

equivalent to lowering the number of colonies of

Streptococcus mutans in vitro. This is evident from the

results of different colonies in the group of Aloe vera and

chlorhexidine group. Chlorhexidine is proven as a better

anti-bacterial material and superior than the Aloe vera. Aloe

vera is proven not having the capacity that is equivalent to

chlorhexidine in terms of reducing colonies of Streptococcus

mutans, but Aloe vera can be used as an alternative option of

anti-bacterial ingredient in reducing the number of colonies

of bacteria Streptococcus mutans, although not as good as

chlorhexidine. In addition, chlorhexidine as chemicals if

used in the long run frequently is reported to cause side

effects and have a bitter taste so poorly received by children.

Thus, Aloe vera can be used as an alternative anti-bacterial

for its safety, no side effects, improving the taste and the

cheaper/more affordable.

6. Conclusion

Based on these results it can be concluded that there is a

significant difference in reduction of the number of colonies

of Streptococcus mutans which were treated by Aloe vera

and Chlorhexidine. In other words, anti-bacterial capabilities

of Aloe vera cannot be equivalent to Chlorhexidine but when

seen from the pattern of decline in the number of colonies of

Streptococcus mutans, it could be an alternative as an

antibacterial material for the prevention of caries.

References

[1] Karpinski TM, Szkaradkiewicz AK. Microbiology of

dental caries. Journal of Biology and Earth Sciences.

2013.3:1.

[2] Henley SCJ, Botha FS, Lall N. The use of plants against

oral pathogens. Microbial pathogens and strategies for

combating them : science, technology and education.

2013. 1375-1384

[3] Kidd, Edwina. A.M. et al. 2005. Essential of Dental

Caries. 3rd ed. Oxford University Press Co. New York.

1-36.

[4] Lakade LS, Shah P, Shirol D. Comparison of anti

microbial efficacy of chlorhexidine and combination

mouth rinse in reducing the Mutans streptocoocus count

in plaque. Journal of Indian Society of Pedodontics and

Preventive Dentistry. 2014. 91-96

[5] Scheie AA, Petersen FC. Antimicrobials in caries

control. Dalam Fejerskov O, Kidd E. Editor. Dental

caries. The disease and its clinical management. 2nd

edition. Blackwell Munksgard. 2008. 266-271.

[6] Parkar SM, thakkar, P, dan Shah K. Antimicrobial

activity of four commercially available mouthwash

against Streptococcus mutan an in vitro study. Univ Res

J Dent. 2013. 3: 106-12

[7] Balagopal S, A. Radhika. Chlorhexidin : The Gold

Standard Antiplaque Agent. Journal of Pharmaceutical

sciences and Research. 2013. 5:12:270-274

[8] Amin M, Kazemi M, Rasaie N. In vitro comparison of

the effects of garlic and chlorhexedine mouthwash on

oral pathogens. Jundishapur J Microbiol. 2012. 5:2.

[9] Buknov N. Which is better, natural herbal or chemical

medicines. 2009.. Diunduh dari :

http://enzinearticles.com/3873647.

[10] Fani M , Kohanteb J. Inhibitory activity of Aloe vera gel

on some clinically isolated cariogenic and

periodontopathic bacteria. Journal of Oral Science.

2012. 54:1: 15-21.

[11] Bassetti A, Sala S. The Great Aloe Book. 1st edition.

Zuccari. 2005. 46-56.

[12] Juneby H. Aloe barbadensia- a legendary medical plant.

Pharmacognosy. Sweden. 2009. 212-234.

[13] Lawrence R, Tripathi P, Jayakumar E. Isolation,

Purification and Evaluation of Antibacterial agents from

Aloe vera. Brazilian Journal of Microbiology. 2009.40 :

906-915.

[14] Pratiwi R. Perbedaan daya hambat terhadap

Streptococcus mutans dari beberapa pasta gigi yang






mengandung herbal. Maj. Ked. Gigi (Dent J). 2005.38 :

2 . 64-67

[15] Neilands J. Acid tolerance of Streptococcus mutans

biofilms. Malmo University. 2007. 50-60

[16] Forsten SD, Bjorklund M, Ouwehand MC.

Streptococcus mutans, Caries and Simulation Models.

Nutrients. Finland. 2010. 2. 290-298

[17] Marsh PD, Nyvad B. The oral microflora and biofilms

on teeth. Dalam Fejerskov O, Kidd E. Editor. Dental

caries. The disease and its clinical management. 2nd

edition. Blackwell Munksgard. 2008. 164-168.

[18] Barandozi FN. Antibacterial activities and antioxidant

capacity of Aloe vera. Organic and Medicinal Chemistry

Letters. 2013.3:5.

Author Profile

Yetty Herdiyati (Indonesia) received DDS from

Universitas Padjadjaran in 1979. She continued to

specialist program in Pedodontics in Universitas

Padjadjaran and graduated in 1995. She finished her

doctorate degree from Universitas Padjadjaran in 2007.

She is a lecturer in Pedodontics Department of

Universitas Padjadjaran. She is also a member of Indonesian

Dentist Association and Indonesian Pediatric Dentist Association.

Mieke Hemiawati Satari (Indonesia) ) received DDS

from Universitas Padjadjaran in 1979. She continued to

post graduate programme in Masters of Health in 1990.

She finished her doctorate degree from Universitas

Padjadjaran in 2003. She is now a lecturer in Oral

Biology Department of Faculty of Dentistry of Universitas

Padjadjaran.

Ratna Indriyanti is a lecturer in Pedodontics

Department of Faculty of Dentistry of Universitas

Padjadjaran

Selly Patawulandari received DDS from Universitas

Padjadjaran in 2002. She continued to specialist

program in Pedodontics in Universitas Padjadjaran and

graduated in 2015.


Documents

Antibacterial Test between Aloe vera and Chlorhexidine ...pustaka.unpad.ac.id/.../uploads/2016/01/...aloe-vera-and-chlorhexidine.pdf · interactions can affect bacterial cell membranes,